Abstract

For some considerable time now the interface between ambulatory and hospital care has been mooted as a cause of inefficiencies in the German health system and there have been calls for a softening of the strict separation between in two sectors. This debate emphasizes the need for detailed empirical information on the interdependence between the two sectors. Using extensive administrative data at the level of the 412 German counties for the years 2007 to 2009 and a simultaneous equation model which allows the numbers of ambulatory and hospital cases to be mutally interdependent, we examine the connection between ambulatory and hospital specialist care seperately for ten medical specialties. The results show that the interdependence of ambulatory and hospitaö services is far from homogeneous. The relationship dependes, on the one hand, on the specialty and, on the other, on the direction of the effect observed. This hetereogeneity needs to be taken into account for cross-sector needs-based planning.